Background: Drug-resistant tuberculosis (DR-TB) is the major cause of mortality worldwide. Our objectives were to determine the distribution of DR-TB by sex, age groups, occupation, province, division, district, type of disease, type of drug resistance, treatment regimen and outcome of treatment in DR-TB population in D.I.Khan Division, Pakistan.Materials Methods: This cross-sectional study was conducted in Department of Community Medicine, Gomal Medical College, D.I.Khan, Pakistan. A sample of 286 DR-TB patients was selected consecutively from population at risk. Sex, age groups, occupation, province, division and district were demographic while type of disease, type of drug resistance, treatment regimen and outcome of treatment were research variables. All variables being nominal were described by count, percentage cumulative percentage with 95% confidence interval for proportion. Distribution of DR-TB patients by all the ten variables were substantiated by chi-square goodness-of-fit test.Results: Out of 286 DR-TB patients, 123 (43%) were men and 163 (57%) women. DR-TB cases were most prevalent in age group 15-44 years 172 (60.14%), housewife 140 (48.95%), Khyber Pakhtunkhwa 175 (61.19%), D.I.Khan Division 178 (62.24%) and district 121 (42.31%). Most common type of disease, drug resistance and treatment regimen was pulmonary TB 282 (98.60%), MDR 273 (95.45%) and longer treatment (n=273 MDR-TB) 246 (90.11%) respectively. Treatment success rate was 161 (56.29%). The observed prevalence by occupation, province, division, district and type of disease in our sample was similar to expected prevalence in population (p.05 for all), while it was different from population by sex, age groups, type of drug resistance, regimen and treatment outcome (p.05 for all).Conclusion: The prevalence of DR-TB was higher in women, age group 15-44 years, housewife, Khyber Pakhtunkhwa and D.I.Khan Division and District. Most common type of disease, drug resistance and treatment regimen was pulmonary TB, MDR and longer treatment respectively. Treatment success rate was 56.29%. The observed prevalence by occupation, province, division, district and type of disease in sample was similar to population, while it was different by sex, age groups, type of drug resistance, regimen and treatment outcome.

Thyroid hormones are involved in the control of insulin secretion, beta-cell function/multiplication, liver glucose synthesis, output and peripheral utilization. Thyroid dysfunction identification and correction help in glycemic control. Objective: To know the frequency of thyroid dysfunction in diabetic patients. Methods: This descriptive cross-sectional study was done in the Medical-C Department, Ayub Teaching Hospital Abbottabad from July 2018 to August 2019. Total 150 diabetic patients were enrolled by using non-probability consective sampling. Patients were labelled as diabetics on the basis of diabetes history, anti-diabetic medications use, high blood glucose (>200mg/dl) on presentation or on previous high blood sugar reading or a high HbA1c value. Fresh venous blood sample was sent for thyroid function tests (T3, T4 and TSH). Thyroid dysfunction in our study was defined as patient having Thyroid Stimulating Hormone (TSH) value above or below the normal range.  Data of patients were collected on study pro forma and was analyzed using statistical program SPSS version-20.0 Results: There were 67 (44.66%) male and 83 (55.33%) female patients. The mean age was 51.83 ± 14.52 years. Thyroid dysfunction was detected in 37 (24.66%) study participants. Out of 67 male patients, 11 (16.41%) had thyroid dysfunction and out of 83 female patients, 26 (31.32%) had thyroid dysfunction. Subclinical hypothyroidism was present in 4 (2.7%), 5 (3.3%) had hypothyroidism, 20 (13.3%) had subclinical hyperthyroidism and 8 (5.3%) had hyperthyroidism. Conclusion: This study suggests that a significant portion of diabetic patients suffer from thyroid dysfunction.

Background Port-a-catheter insertion and removal are common procedures performed for children with chronic disease or cancer. Although its removal is usually straightforward, some difficulties during the procedure can be encountered. Several methods have been described in the literature to handle those cases where lines have become stuck. Aim To describe our simple technique in dealing with stuck port-a-catheters during removal. We will additionally report the incidence and factors associated with this complication. Methods A retrospective chart review study was performed between January 2009 and December 2019. Of a collective 2040 ports that were removed during the research interval, cases of difficult port removal were collected and reviewed. In 42 cases, catheter removal difficulty is encountered, and a second incision at the venous access site is performed. Failure of this procedure in removing the stuck catheter is then followed by catheter stenting and removal over a guide wire. Results Difficult removal of port-a-catheters was experienced in 42 cases (2%). The mean age at removal for those cases was 6.6 years. Most of the port-a-cath removals were done after treatment completion (74%). Ports had been left in situ for a mean duration of 44 months. The stepladder technique with wire stenting of the catheter was successful in 37 cases (88%), while the rest were only partially removed (distal part). The retained part was extracted using an angiographic technique. No short- or long-term complications were encountered in any of those 42 patients. Conclusions Stepladder with wire stenting of catheters approach deals with difficult line removals. Our technique is, therefore, simple, feasible, and effective. Level of evidence IV.

cell infiltration. In contrast, no WT1 expression was observed when disease was absent. Our findings suggest an association between the emergence of WT1-specific T cells and graft-versus-myeloma effect in pts being treated for relapsed MM.